At some point in time, we all have experienced a rolled or sprained ankle, a muscle pull, or some sort of strain in our back or neck. These are normal things that happen in day to day life, but how do we know when things are healed?
Every injury has a process of inflammation, repair, and remodeling. The healing time various based on the type of injury.
A muscle strain or pull generally takes 2-4 weeks for a full healing time. You may have decreased pain and virtually no symptoms after 1 week, but the tissues still are being repaired and rebuilt to become 100% again.
A tendon is a much stronger structure; therefore an injury or partial tear is caused by a greater amount of stress, creating a longer healing time. Full healing times may take 6-12 weeks and can still be remodeling for up to a year.
A ligament is the strongest soft tissue structure. An injury to this will take approximately 12-16 weeks up until a year as well.
Bones generally require 6-8 weeks to be fully fused and healed again, and can take longer pending if the body is to be non-weight bearing at first.
When an injury occurs repeatedly, usually, this is in the window prior to full healing. As in the case of a muscle strain, symptoms may have resolved, but the full healing process has not been completed, leaving the tissues to be in a more vulnerable position to be restrained again. A previous injury to an area increases the likelihood of a repeat injury. If full times are respected with general strengthening and movement, without reaggravation, then the likelihood of a repeat injury will drastically drop.
Post-surgical healing times vary as it is dependent on how much was repaired and how long tissues may be non-weight bearing vs being able to be loaded right away. Surgical repairs may speed up healing time, but due to the nature of other structures being cut and moved, the healing may be increased as the other structures need to catch up.
Let's say you have a chronic tendon strain, you can still do some form of training to help speed up the recovery. Chronic strains and tendinopathies tend to be stiff and less compliant tissues, which cause pain, even if the theoretical tissue healing time has passed. There is still a restriction or aggravation to the tissue causing the issue. Using the concept of stress relaxation, we can hold a static position at bodyweight for a minimum of 30s up to 5min (building over a very long period of time, of course). Ideally, getting up to 90s will be quite a sufficient hold time for most injuries.
The duration of the hold allows the muscle to shorten over time and create a lengthening of the connective tissues/tendons so they can become more compliant and better able to absorb forces and adapt to movements. Below is an example of a yielding isometric in a split-squat hold where the body is not fully lowered down. Hold a controlled position for the desired time and build up weekly in total time by 5-10s.
This can be applied to a number of different exercises, but in this example, it would be for patella/quad tendon strains/tendinopathies.
It should be noted that if you get wobbly during the exercise (like I did, ugh), you may want to have a band or hand support to establish a solid base and progress to decrease the support. This may be your first progression before adding time.
If you need more ideas on how to implement this into your training, inquire about working with us.
Dr. Peter Dionisopoulos is the owner and founder of Dynamic Performance & Rehab. He has worked with many high-level athletes and military personnel, but his true passion is to help active adults maintain their lifestyle by providing information and potential solutions to their aches and pains so they can continue with the activities they love.